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Clinical outcome and hemodynamic changes following HCV eradication with oral antiviral therapy in patients with clinically significant portal hypertension
- Source :
- Journal of Hepatology. 73:1415-1424
- Publication Year :
- 2020
- Publisher :
- Elsevier BV, 2020.
-
Abstract
- Clinically significant portal hypertension (CSPH), defined as a hepatic venous pressure gradient (HVPG) ≥10 mmHg, persists 24 weeks after sustained virological response (SVR) in up to 78% of patients with HCV-related cirrhosis treated with direct-acting antivirals. These patients remain at risk of decompensation. However, long-term paired clinical and hemodynamic data are not available for this population.We conducted a prospective multicenter study in 226 patients with HCV-related cirrhosis and CSPH who achieved SVR after antiviral therapy. Patients with CSPH 24 weeks after end of treatment (SVR24) were offered another hemodynamic assessment 96 weeks after end of treatment (SVR96).All patients were clinically evaluated. Out of 176 patients with CSPH at SVR24, 117 (66%) underwent an HVPG measurement at SVR96. At SVR96, 55/117 (47%) patients had HVPG10 mmHg and 53% had CSPH (65% if we assume persistence of CSPH in all 59 non-evaluated patients). The proportion of high-risk patients (HVPG ≥16 mmHg) diminished from 41% to 15%. Liver stiffness decreased markedly after SVR (median decrease 10.5 ± 13 kPa) but did not correlate with HVPG changes (30% of patients with liver stiffness measurement13.6 kPa still had CSPH). Seventeen (7%) patients presented with de novo/additional clinical decompensation, which was independently associated with baseline HVPG ≥16 mmHg and history of ascites.Patients achieving SVR experienced a progressive reduction in portal pressure during follow-up. However, CSPH may persist in up to 53-65% of patients at SVR96, indicating persistent risk of decompensation. History of ascites and high-risk HVPG values identified patients at higher risk of de novo or further clinical decompensation.As a major complication of cirrhosis, clinically significant portal hypertension (CSPH) is associated with adverse clinical outcomes. Herein, we show that CSPH persists at 96 weeks in just over half of patients with HCV-related cirrhosis, despite HCV elimination by direct-acting antivirals. Despite viral cure, patients with CSPH at the start of antiviral treatment remain at long-term risk of hepatic complications and should be managed accordingly.
- Subjects :
- Liver Cirrhosis
Male
0301 basic medicine
medicine.medical_specialty
Cirrhosis
Sustained Virologic Response
Portal venous pressure
Population
Hemodynamics
Hepacivirus
Antiviral Agents
Risk Assessment
Gastroenterology
Time
03 medical and health sciences
0302 clinical medicine
Internal medicine
Hypertension, Portal
Ascites
medicine
Humans
Decompensation
education
education.field_of_study
Hepatology
business.industry
Hepatitis C
Hepatitis C, Chronic
Middle Aged
medicine.disease
030104 developmental biology
Liver
Spain
Disease Progression
Elasticity Imaging Techniques
Portal hypertension
Female
030211 gastroenterology & hepatology
medicine.symptom
business
Follow-Up Studies
Subjects
Details
- ISSN :
- 01688278
- Volume :
- 73
- Database :
- OpenAIRE
- Journal :
- Journal of Hepatology
- Accession number :
- edsair.doi.dedup.....6335ab15240777cd53477fb6d2dab0e9
- Full Text :
- https://doi.org/10.1016/j.jhep.2020.05.050